Leadership Strategies That Reduce Stress

Clint Maun, CSP

Stress of all kinds has pummeled the healthcare industry. Facilities
are expected to deal with managed care competition, major reimbursement
changes, staffing concerns, regulatory compliance changes, consumer
awareness issues, media problems and tougher acuity. It's no wonder
some people want to throw up their hands and run screaming into the
night!"

We believe it is possible to work through this change, chaos, turmoil
and stress. It requires however, strong leadership throughout the
organization beginning with the management team. When you're in a
stressful situation, it boils down to how you act or react to that
situation, versus letting the situation take control of you.

Stress has been defined as conflict between the mind and body. Negative
stress can result in problems for the organization including morale
issues, apathy, absenteeism, turnover, customer service problems,
quality issues and general disarray on a daily basis.

Today's healthcare leader must have specific techniques for handling
stress inside the facility on a daily basis. It's impossible to focus
on issues that are beyond your control or concern reducing stress. You
have to focus upon techniques and strategies that can be implemented by
the facility on an ongoing basis. Some of these strategies include:

Focus on take-offs. "Take-offs" are the facility's ability to get
started for the day in the proper manner. Airports and airplanes strive
for smooth take-offs to ensure a successful start of the flight. If
scheduled "take-offs" are a few minutes late at the beginning of the
day, by the end of the day "take-offs" can be off by as much as several
hours.

The facility must deal with its "take-off" behaviors and set in motion
leadership by charge nurses, unit managers and department heads
regarding the first ten minutes of the start of the day, shift report,
meeting or conference. Also, ensure that the pre-breakfast experience
is positive, upbeat and successful.

Leadership in the management role includes the ability to police
negative statements; lethargic attitudes, shift change rituals and
other issues that affect the "plane" to take off on time and on target.
Leaders need efficient, effective solution-oriented shift reports. They
should deal directly with any "baton passing" between shifts ensuring
they are effective, solution oriented and efficient. Most importantly
the staff must understand shift changes are not the time for
complaining, griping or passive/aggressive statements about the shift
that just left the building.

Organizations add stress to their day by not accomplishing everything
by the end of a shift, and then spending 30-45 minutes at the start of
the shift adjusting and getting themselves ready.

Leadership sets the tone for each and every day. Our "planes" must be
loaded effectively, ready to both "take off" and "land" on time.

The same holds true for the start of care planning conferences, staff
training sessions, department head meetings, staff meetings, etc.
Agendas must be focused, solution-oriented and prioritized. All
meetings must start on time, and address the most important issues
first.

Allowing even one person to take a meeting off target or off agenda
causes it to start late. Giving an individual's negative statements
control over a meeting will cause the creation of more stress. When
"other" issues sidetrack the purpose of a meeting, managing stressful
situations will be impossible. For more information go to Operating
Solution Oriented Meetings.

It's important for health care organizations to create a
successful set of outcomes within the first seven hours of the day.
Whatever happens between 6 a.m. and 1 p.m. sets the tone for the
remainder of the day. This advice applies to both hospital settings and
skilled nursing facilities.

We're not saying the other seventeen hours running smoothly is not
important, but if you can't make the first seven hours run
successfully, you won't be able to deal with the issues that affect the
rest of the day. During that first seven hours many things must be
accomplished including:

Activities of daily living (ADL's)

Two meals or dining experiences

Physician's examinations and visits

Testing procedures

Treatments performed

Medications administered

Therapies provided

Recreation Therapy activities and,

Any other ongoing delivery systems

We're suggesting that organizations closely examine these first seven
hours to determine if they need re-engineering to make them as
successful as possible and thus reducing stress. For more information
go to Seven Sets Up Seventeen.

Too many health care organizations are still holding on to old,
hierarchical systems and structures that are not efficient or effective
with 21st Century workers and work situations. "Top-level" managers,
the administrator and the DON should be focused and available
throughout the building(s) and "out on the floor" during the first
seven hours of the day. If these individuals are "holed" up in their
offices responding to corporate requests, e-mails, and paperwork they
are missing opportunities for lively leadership involvement that can
keep crisis management to a minimum.

We suggest staff training programs be adjusted to run small modular
training with two or three people on the units as needed, rather than
all-staff meetings or in-services. We also suggest asking visitors,
vendors, and others to please make contact with us at a time that
doesn't interfere with the busiest parts of the day.

It is our belief that if you can make it to one o'clock in your health
care facility with a successful tone for those seven hours you will
experience other victories throughout the afternoon and evening.

If the "chaos" of a poor "take-off" continues into the afternoon, it
will be passed on to the evening and night shifts. (We call this
negative "continuity of care" the "cycle of doom.")

In skilled nursing facilities, six hours of a resident's life is
spent in the pre-dining, actual-dining or post-dining experience. Even
in hospital settings, the quality of food and activities surrounding
the meal event represent the greatest opportunity for a positive or
negative customer experience.

Make certain meals are a wonderful team-based, smooth, pleasant
experience for the customers and employees. All too often the dining
experience degenerates into three "milkings" where diners are herded
like cows into the barn for their milking. Too many organizations have
turned meals into an institutional production line that produces stress
for the patients, residents and families, and the staff.

We produce three meals a day and two of them are in the first seven
hours of the workday. Most of the things that affect CMA's (HCFA's)
interpretation of a successful skilled nursing facility occur around
mealtimes. This is when treatments, rehabilitation training, medication
dispensing, activities of daily living, and documentation processes
occur. If things are chaotic around mealtimes then opportunities for
successful regulatory compliance will not happen.

The administrator, DON, department heads and other team members must be
involved in the dining experience. They should be visible during
mealtimes, particularly on nights and weekends when families and other
guests are most likely to visit.

These leaders should be directly involved in making successful
inter-departmental interchanges happen, and that "turf free" working
relationships are being encouraged(especially between the dietary and
nursing staff). For more information go to Meals or Milkings.

Another way to cause unnecessary stress in health care
organizations is to not cross-train staff in critical organizational
functions. For example, if the Minimum Data Set (MDS) nurses are the
only ones in a skilled nursing facility that understand the MDS,
reimbursement and how the Prospective Payment System (PPS) works, those
MDS nurses will feel stress as they make certain no mistakes are made.
At the same time, everyone else will feel stressed out as well (or
should be), having handed the organization's financial well being to
these few individuals.

Putting the responsibility for quality on a few Quality Assurance
individuals vs. the entire QA team will result in heightened stress
throughout the organization. We argue Quality Assurance is a primary
responsibility for every person in the organization.

In another example, setting up a situation where only a few at the top
are responsible for all interviewing and hiring opens the door for
others to gripe, whine and complain about the quality of new hires
and/or not having enough staff. To make matters worse, without the
involvement of a new-hire's co-workers there is an increased
probability of new staff being run off by the "old-timers."

We are suggesting, "Everyone needs to be concerned with everything."
Everyone has the responsibility to be involved with the budget.
Everyone has the responsibility to be worried about the census.
Everyone has the need to be concerned about regulatory compliance and
survey. Everyone needs to be involved proactively with employee
turnover reduction and our recruitment strategy.

By setting up team-based responsibility and knowledge about information
that is affecting the organization, we promote teamwork - thereby
reducing stress because it doesn't put the load on any one individual.

This means that the management and leadership teams must develop an
open-book strategy. Share information. Be willing to talk about key
indicators, targets, results and numbers that are affecting success.
Tie everyone into team-based involvement and improvement activities
that lead toward success in measurable ways.

In summary, by focusing upon a leadership team that promotes openness,
communication, and targeted outcomes, we are at the same creating a
situation where we reduce finger pointing, blaming and "turf-wars." By
beginning our "take-off" behaviors as a group it is easier to move
toward the dedicated efforts of critical group involvements such as
meals. This sends a "can-do" message and attitude throughout the
organization, which contributes to a "can do" opportunity for
accomplishing superior results.

This "can-do" attitude helps us stay focused on the things we can
control and worry less about what's being "done to us" from the
outside. When we take charge of our work lives within the organization
we will have an appropriate sense of accomplishment. Over time, this
leads to the various teams being capable of dealing with the more
negative individuals by saying to complainers, moaners and groaners,
"If you have a problem what is your solution?" These moaners, groaners,
whiners, complainers are then placed on the spot to put up or shut up,
because the new way of operating within the organization is solution
oriented. This attitude will be successful on a daily basis for
everyone's benefit.